Caffeine and alcohol don't mix

How drink makers exploit teens and what Ventura County is doing about it

In his presentations on the hazards of alcoholic energy drinks around Ventura County, administrator of the Behavioral Health Department Dan Hicks likes to show a photograph of the aftermath of a horrific accident in 2007.

A car driven by a young man hit a tree so hard it nearly came apart.

“This accident happened at the intersection of Williams and Gonzales, which is right outside my office,” he said. “The Oxnard police responded, and they interviewed the passenger and asked him if he had been drinking. ‘Well, we had some energy drinks,’ ” he said.

In the car, the police found a can of Joose Blue, which is nearly 9 percent alcohol by volume, in a can about twice the size of a beer can, which makes it equivalent to close to four beers, though it costs about $2.50.

“That was a real eye-opener,” Hicks said. “The fact that they survived says a lot more about the side impact bags on a Nissan than it does for the skills of a driver on ‘Joose.’ ”

Even Hicks, who has been working to reduce underage drinking in the county for nearly five years, hadn’t fully realized how popular alcoholic energy drinks were among young people — and how little adults knew about the risks.

“It’s sort of like a generation gap in awareness,” he said. “When I was a kid in high school, we used to hide our beers in plastic wraps. Today, the beverage companies take care of that for you. A lot of adults don’t even know that energy drinks can contain alcohol. A counselor in San Diego gave a presentation to some teachers at a middle school, and went out at lunchtime and counted 12 students with alcoholic energy drinks. They didn’t need to conceal it because the adults didn’t even know these drinks existed.”

Hicks points out that beverage manufacturers market the alcoholic energy drinks — which contain the same potent blend of caffeine and other stimulants as do conventional energy drinks — almost exclusively to young people, many of them underage drinkers, spending millions on online marketing, and very little on the traditional advertising forms seen by adults.

“I don’t think it’s a mistake by the stock boy at your local convenience store that the Monster Nitrous happens to be placed right next to the Jaegermeister,” Hicks said. “That’s 2,000 milligrams of caffeine and other stimulants, equivalent to nearly seven cups of coffee, and they’re encouraging people to mix this with distilled spirits. Do that and you’re guaranteed to have trouble.”

In Thousand Oaks, City Councilwoman Jacqui Irwin has been leading efforts to educate the public about the risks of mixing spirits and stimulants. “These drinks are dangerous,” she said. “Keeping people awake so that they can drink longer is not safe. If you have two large-volume cans of some of these alcoholic energy drinks, you’re having the equivalent of 15 cups of coffee and seven shots of whiskey.”

In 2007, Irwin was appointed by the Thousand Oaks City Council to work with Hicks, the Behavioral Health Department and other health advocates to reduce underage drinking in Ventura County. In October, she convinced her fellow council members to unanimously approve an ordinance requiring city businesses in Thousand Oaks to post signs warning customers of the dangers of mixing stimulants and alcohol.

City officials say Thousand Oaks is the first city in the nation with such a regulation.

“We’re not abolitionists, but we’re trying to hold the alcohol industry responsible,” Irwin said. “The marketing of these drinks has been completely viral, and a lot of parents are totally unaware of what is going on. Companies are targeting underage drinkers, putting out alcohol products with unregulated stimulants and tiny warning labels — the industry has been really deceptive.”

The signs, which will be made up by the Behavioral Health Department, will say: “Warning: Consuming energy drinks that contain or are mixed with alcohol may mask the signs of impairment and INCREASE YOUR RISKS OF INJURY.”

How the alcohol industry profits from underage drinking

On Nov. 13, following the lead of the attorney generals from California and 10 other states, the Federal Drug Administration warned 30 makers of alcoholic energy drinks that it was considering whether it was lawful to add caffeine to alcoholic products, including such drinks as Vicious Vodka with Caffeine, Joose, Evil Eye and Hard Wired.

“The increasing popularity of consumption of caffeinated alcoholic beverages by college students and reports of potential health and safety issues necessitates that we look seriously at the scientific evidence as soon as possible,” said administrator Dr. Joshua Sharfstein.

Will alcoholic energy drinks be banned?

California and other states earlier this year succeeded in pressuring Anheuser-Busch to discontinue manufacture of its alcoholic energy drinks Tilt and Bud Extra.

Now the Federal government appears ready to act as well.

Health advocate and attorney Jim Mosher, who has been calling for regulation of alcoholic energy drinks for a nonprofit health firm for several years, believes the FDA warning will be a turning point.

“Adding caffeine to alcohol is equivalent to putting an upper and a downer in a single product. This creates significant health and safety risks,” he said. “We know this from the science. But when we first started working on this issue, we could not get the attention of any federal agencies.”

Under federal law, manufacturers must show that any substance deliberately added to a food or beverage sold in the United States must be “generally recognized as safe” (a standard known as GRAS). Mosher doubts that alcoholic energy drink manufacturers will be able to meet that test.

“Under FDA rules, manufacturers have to establish before they put additives in any food or beverage that the products are safe,” he said, “But all the scientific studies we have seen say that it’s not safe.”

Mosher points to a study published last year by a doctor at Wake Forest, Mary O’Brien, which showed that college students who consumed alcoholic energy drinks had “a significantly higher prevalence of being taken advantage of sexually, taking advantage of someone else sexually, riding with a drunken driver, or being physically injured,” even in comparison to those who drank alcohol, but without caffeine.

Mosher also documented efforts by the alcohol industry to market to young drinkers. In a 2007 report for the Marin Institute, he and a co-author revealed that alcoholic energy drinks such as Tilt, Rockstar 21, and Sparks cost about 25 percent less than comparable nonalcoholic energy drinks such as Rockstar Juiced, Lost Energy and SoBe Adrenaline Rush.

The alcoholic energy drinks at the time cost about $1.50, versus about $2 for conventional energy drinks.

The report alleged that the alcohol industry created confusion in the minds of consumers, retailers and law enforcement officials by marketing energy drinks with alcohol that look almost exactly like conventional energy drinks.

It singled out the company Rockstar, arguing that its alcoholic energy drink, Rockstar 21, was “nearly impossible” to tell apart from its nonalcoholic energy drinks.

Rockstar, whose products are marketed with the tagline “Party like a rock star,” went from sales of $1 million a year in 2004 to more than $77 million in 2006. The company’s products, which are now distributed by Coca-Cola, subsequently dropped the alcoholic version of the drink from its line.

The energy drink market is crucial to beverage manufacturers. It took off this decade, with sales jumping nearly 40 percent in 2006, and nearly 30 percent in 2007, according to data from the Neilsen Company. The industry is expected to notch $5 billion in sales in 2009, and 18 percent of revenue from drinks sold in convenience stores comes from energy drinks, according to the industry publication Convenience Stores News. This year, 270 new energy drinks were introduced, as sales of soda drinks declined slightly, while juice drinks and sports drinks were also flat.

A waitress at a popular downtown Ventura bar, who did not want to be named, said that on weekends she sells 100 Red Bull and vodka drinks a night.

“Stoli and Red Bull, Grey Goose and Red Bull — I hear that all night long,” she said. “When my boyfriend and I go to Las Vegas, that’s what we drink. If you’re a little tired, it’s a drink people like to have.”

Red Bull was inspired by a drink popular in Thailand in the l980s, and reformulated and marketed in Europe by an Austrian named Dietrich Mateschitz, who was convinced the Thai drink helped him overcome jet lag. Mixing Red Bull with vodka became popular in European bars in the l990s, it spread to New York, and now has taken off across the nation. Although the taste has been criticized, even by fans, it is the most popular energy drink around the world by a wide margin, and has made Mateschitz one of the world’s richest people, with an estimated new worth of at least $2 billion, according to Forbes.

Red Bull’s popularity soared at the same time that European-style coffee drinks became enormously popular.

Starbucks went from 165 outlets in l992 in this country to more than 16,000 around the world today. Caffeinated drinks such as lattes have become so popular that McDonald’s this year spent an estimated $100 million launching a new “McCafe” line, selling sweetened coffee drinks at lower prices than Starbucks around the country.

If teens don’t drink alcoholic energy drinks, what do they drink?Health advocates worry less about coffee, which has long been popular, and whose health effects have been thoroughly studied, than about the alcohol industry seducing underage drinkers with sweetened alcoholic products.

They argue that the industry is targeting inexperienced teenagers who like soft drinks but not traditional alcoholic drinks. These “alcopops” have trade names such as Bad Jelly, Mike’s Hard Lemonade and Red Russian.

“These are like soda pops, but with topical labels,” Irwin said. “They are marketed to young girls who don’t like the taste of beer. They’re still regulated as beer, because they begin with a malt base, but manufacturers distill out the malt taste, and then market them to girls as a transition drink to hard liquor.”

Mosher cites studies that show that high school students aged 12 to 18 drank 35 percent of all the alcopops sold in the United States, according to a survey by the Inspector General, and that they were the favorite alcoholic drink of 42 percent of underage drinkers. Although the alcohol industry claims that the drinks are marketed to “new drinkers” legally allowed to drink alcohol, Mosher points out that the vast majority of new drinkers surveyed say they began drinking in their teens, usually by the age of 14. According to a survey conducted by Ventura County Behavioral Health Department, 70 percent to 85 percent of teenagers report that alcohol is “easy to obtain,” and home parties are the most likely location for teen drinking.

How much are underage drinkers drinking? Although health advocates such as Hicks and Mosher believe the alcohol industry has set out to seduce teenagers into drinking, what concerns them most are the high percentages of underage drinkers who report binge drinking and the reckless behaviors that can result from out-of-control drunkenness. To make his point, Mosher cites a survey of California high school students on teenage drug use, published last year by three state agencies, including California Attorney General Jerry Brown’s office.

According to the survey, “Students who binged at least once consisted [of] 43 percent of the current drinking population in seventh grade, 58 percent in ninth grade, and 69 percent in 11th.”

Almost half of 11th graders reported getting very drunk or sick from alcohol, and of that number, half reported getting very sick or drunk on three or more occasions.

Katherine Kasmir, who leads a health education dramatic group called “Straight Up Ventura!” says that her group’s work with thousands of teens around the county backs up these statistics.

“Parents don’t realize how much drinking is going on now,” she said. “That’s what parents tell us when they see our performances. They usually hadn’t thought that with the Internet and texting, people of any age can show up at these teenage parties. We have girls passing out, boys playing games and drinking competitively and suffering [from] alcohol poisoning. It’s a much more dangerous environment than parents realize.”

At Ventura College on a Tuesday night, Kasmir shepherds eight teens through a performance that she says is based on accounts from some of the 5,000 young people her group has worked with in the county. The performance, which is sometimes staged as a “reality party” in a home in the county for visiting parents, dramatizes drinking games, the ease with which teens can get alcohol, and the obliviousness of adults who don’t see what is going on right under their noses, often in their presence.

Hicks, who helped win a $900,000 federal grant to combat underage drinking in the county in 2005, and who has backed the group’s efforts, also asked the sheriff’s department to look into statistics on binge drinking. Commander Geoff Dean of the sheriff’s department had his staff go through three years of records from the major crimes unit and found that 70 percent of the young women in the county who had been raped were coming out of alcohol parties in which there had been binge drinking by women.

Hicks points out that “alcopops” are about twice as powerful as beer, and almost could have been designed by a sexual predator hoping to get a young woman drunk.

“If you’re a young woman who weighs 100 or 110 pounds, and you think you’ve had two of these sweetened high-alcohol beverages, you’ve actually had about twice as much as you think you’ve had, and you don’t know how drunk you are,” he said.

Kasmir agrees, and points out that the teens she talks to tell her again and again — even the ones who drink — that underage drinking is “out of control.”

“We stage our performances based on what kids tell [us] is normal at parties for ‘good kids,’ ” she said. “These are not extreme situations for teens at all.”

To Irwin and Hicks, the recent action taken by Thousand Oaks, warning of alcoholic energy drinks, and the county-wide Social Host Ordinance designed to crack down on party-hosted teen drinking, are what the county needs to do until federal authorities look at the problem on a national level.

“The FDA should step in,” she said. “We should not have to do this. It’s so obviously not safe.”